Aesthetic physicians continue to battle cellulite, although some have seen success in at best temporary reduction of cellulite using radiofrequency (RF)-based devices. As the technology behind energy-based devices grows increasingly sophisticated, a handful of manufacturers have developed products that show promise in some success in the ongoing war.

To help take the pulse of this industry, PSP spoke with Jason Pozner, MD, FACS, whose Sanctuary Plastic Surgery operation is located in Boca Raton, Fla, and who has commented throughout the media on medical devices.

Choose wisely, he says. “You’ve got to pick them up and start using them early. You never know when the device you are using will get superseded,” he notes. “Some of the devices I’ve had for 10 years, and I still use them.”

A selection of these technologies and products include the following:The Accent, from Alma Lasers Ltd, Buffalo Grove, Ill) and Thermage (Solta Medical Inc, Hayward, Calif) are noninvasive radiofrequency devices for tightening and contouring skin.

One of the oldest techniques available for cellulite reduction is endermologie, which uses a system of rollers and is primarily a mechanical system to reduce cellulite and intercellular swelling.

The Velashape system (Syneron Medical Ltd, Yokneam, Israel) was the first FDA-approved device of its kind. It relies on a vacuum and mechanical system combined with RF energy delivery and an infrared light. The latter two help to deliver energy to the subdermis and to the fat.

“All of the devices out there are radiofrequency, except for one ultrasound device from Sound Surgical,” Pozner says. “The VASER Shape.”

As with most of these devices, aesthetic physicians usually mix and match therapies. For example, methods of smoothing the skin surface include heat application, which tightens the skin surface and increases tissue health with improved circulation, and/or a complimentary therapy that might involve other energy-based devices, enzyme therapy, etc.

All of these products and platforms achieve dermal tightening of the fibrous septae, enhancement of local blood circulation (vasodilatation and hyperemia) and drainage of fatty deposits to the lymphatic system, and fatty acid dissolution and thermal-induced fat cell apoptosis.

When asked, Pozner agrees that there has been a boom in new energy-based devices. Many are proven and some are unproven in the marketplace. Yet, very few manufacturers offer devices that work even reasonably well for cellulite reduction, if at all.

“I think that’s accurate,” Pozner says. “Most of the devices out there that seem to operate using the same mechanics—to heat the skin, to cause tightening of the skin to correct a problem. Some of them can make some of the feathering go away, and that helps. Every couple of years, the devices get a little better at solving the problem.”

Many devices are good at what they do, Pozner says. However, he points to a lack of published results as holding back the industry. To date, there is no peer-reviewed, blinded, controlled, gold standard report, he notes.

Nonetheless, that does not stop most practitioners that have seen measurable results using energy-based devices. “In our practice, we use a combination of Velashape along with Accent,” Pozner says. “We also mix and match with different devices. The RF devices give you good penetration, good heating. When you get rid of all the hocus pocus, what these devices do is heat the skin. And when skin gets to a high enough temperature for long enough, you probably produce a contraction response in most people.”

Cellulite-reduction procedures work better on some patients over others, and ultimately no one really knows why. “The problems are with any cellulite-reduction or skin-tightening technology,” Pozner says. “We still don’t know who are going to be the best responders and who are going to be the poor responders.”

Sometimes, outcomes can be predicted for certain patient types. For example, there might be a 90% chance of improvement in a 31-year-old nonsmoker who is mildly athletic, Pozner suggests. However, in the case of a sun-worshiping, middle-aged woman, “Some patients are less likely to succeed in cellulite reduction and may, in fact, have other skin-related problems that need attention.”

THE FUTURE LOOKS BRIGHT

According to Pozner, the techniques and technology will improve over time. What is needed to push the technology along? “Better imaging technology,” he says. “I think the Ulthera concept of measuring and then shooting based upon what you find is going to be the way these manufacturers advance to the future.”

In his dreamy moments, Pozner imagines a next-generation computer-controlled CT-scan and MRI-based device able to measure skin characteristics and deliver an objective assessment. “In 3D,” he adds. “It is an exciting time, and we are going to see a lot of new advances over the next 10 years.”

Jeffrey Frentzen in the editor of PSP. He can be reached at plasticsurgery@allied360.com.